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Labial adhesion and urinary tract problems: The importance of genital examination
Engin Melek1, Fatih Kılıçbay2, N G Sarıkaş3
1Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey; Department of Pediatrics, Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey.
Insights
Labial adhesion (LA) in girls is linked to a higher risk of urinary tract infections (UTIs). Prompt genital examination can detect LA, preventing recurrent UTIs and unnecessary investigations.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Pediatric Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in children and can lead to renal damage if untreated.
- Labial adhesion (LA) is a recognized risk factor for UTIs in girls.
- Early detection and treatment of UTIs are crucial to prevent renal scarring.
Purpose of the Study:
- To highlight the significance of performing genital examinations in girls presenting with nephrourologic symptoms, especially UTIs.
- To emphasize the association between labial adhesion (LA) and the occurrence of UTIs in pediatric patients.
- To underscore the importance of detecting LA for timely management.
Main Methods:
- Retrospective analysis of medical records from 46 girls diagnosed with labial adhesion (LA).
- Data collected included patient age, LA thickness (thin, moderate, dense), LA type (partial, complete), UTI history, and treatment outcomes.
- Statistical analysis was performed to determine the association between LA characteristics and UTI presence.
Main Results:
- A significant correlation was observed between the severity of LA and UTI incidence: complete LA (84.0%) and thick LA (100%) showed higher UTI rates.
- 58.7% of girls with LA had a history of recurrent UTIs.
- None of the patients' primary care physicians or pediatricians identified LA during routine examinations.
Conclusions:
- Complete and thick labial adhesions are associated with an increased predisposition to UTIs in girls.
- Treatment of LA resolved UTIs, with no recurrences reported in the study.
- Genital examinations are underutilized in routine pediatric care, leading to missed LA diagnoses and potential delays in UTI management.
Background:
Urinary tract infection (UTI) is a common bacterial illness in children. Delay in the treatment of UTI may lead to acute renal parenchymal damage and subsequent renal scarring. It is well established that several risk factors increase the tendency for UTI - one being labial adhesion (LA).
Objective:
The purpose of this study was to emphasize the importance of genital examination in girls with nephrourologic symptoms, particularly UTIs, in order to detect LA.
Material And Methods:
Data were collected from the files of 46 girls with LA, including: the girl's age, thickness of LA, any recurrence and treatment options of LA, and the reason for admission to hospital. The LAs were grouped in terms of thickness as thin, moderate and dense, and also partial or complete.
Results:
The average age of the girls at the first visit was 51.9 ± 37.57 months (min-max: 3.5-157 months). Twenty-seven (58.7%) of the girls had history of recurrent UTI. There was a marked association between the presence of UTI and the type of adhesions. The percentages of UTIs in girls with complete and partial LA were 84.0% and 28.6%, respectively (P < 0.05). The percentages of UTIs in girls with thick and thin LA were 100% and 44.1%, respectively (P < 0.05). None of the girls' primary care physicians or pediatricians recognized LA at the time of a periodic health examination.
Discussion:
In the present study, girls with complete and thick LA had a greater tendency towards having UTIs than those with partial and thin LA, respectively. After treatment of LA, the UTIs did not recur in any girls. None of the girls in this study had undergone a previous genital examination. Therefore, this study suggests that physicians do not often perform genital examinations. Limitations of this study were the small sample size and the short follow-up period. In addition, although all of the girls were examined by the same physician, the thickness of the membrane is subjective and solely depends on the physician's experience.
Conclusions:
This study showed that although genital examination is a routine part of a physical examination, it is not always performed. Therefore, it is recommend that genital examination should be performed in girls with nephrourologic complaints, particularly for UTI. By timeously determining the presence of LA, many unnecessary and invasive investigations could be avoided in these children.
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